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Trainers’ Guide for Training on Biomedical Waste Management
This document has been prepared for the United Nations Industrial Development Organization (UNIDO) on behalf of the training component of the project “Environmentally Sound Management of Medical Wastes in India” by the Department of Community Medicine, M.S. Ramaiah Medical College, Bangalore. This document has been reviewed and approved by the Ministry of Environment, Forest and Climate Change (MoEFCC), Government of India.
Contributions were provided by Suman Gadicherla and reviewed by Lalitha Krishnappa and C. Shivaram, M.S. Ramaiah Medical College, Bangalore. Contributions and inputs were also provided by the Ministry of Environment, Forest and Climate Change, the Government of India; the Central Pollution Control Board; the State Pollution Control Boards, Health and Family Welfare Department and the participating health care facilities of the five project states – Gujarat, Karnataka, Maharashtra, Odisha and Punjab – to produce this document.
Disclaimer: This document has been produced without formal United Nations editing. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the secretariat of the United Nations Industrial Development Organization (UNIDO) concerning the legal status of any country, territory, city, or area or its authorities, or concerning the delimitation of its frontiers or boundaries, or its economic system or degree of development. Designations such as “developed”, “industrialized” and “developing” are intended for statistical convenience and do not necessarily express a judgment about the stage reached by a particular country or area in the development process. Mention of firm names or commercial products does not constitute an endorsement by UNIDO.
Copyright © 2018 by the United Nations Industrial Development Organization
Edition: First published in India, 2018
Acknowledgement
rfr$.frenC.K.Mishra
Government of India, Ministry of Environment, Forest and Climate Change (MOEFCC)is the nodal agency for the India's environmental and forestry policies and programmes. Guided by themandates of sustainable development inclusive of lndustrial growth, Govt. of India, signed the StockholmConvention on POPs in 2001 and ratified it in 2006. Post ratification of the Convention, as per ArticleT ofthe convention, National lmplementation Plan (NlP) was formulated which identified " EnvironmentallySound Management of Medical Wastes" as one of the priority areas.
In compliance to the obligations to be met under Stockholm Convention and ensuring sustainableand a pollution free environment, MoEFCC in collaboration with United Nations lndustrial DevelopmentOrganization (UNIDO) has been implementing a pilot project entitled "Environmentally SoundManagement of Medical Waste in India" in the five states of India viz. Gujarat, Maharashtra, Karnataka,Odisha and Punjab.
Amongst many other, two of the major objectives of the prolect includes capacity building interms of skilled and trained medical professionals with knowledge and sensitivity towards safe handling,treatment and disposal of medical waste in an environmentally sound manner and; establishment ofBAT and BEP across the domain of medical fraternity including the waste handlers and the MedicalWaste Treatment Facility operators.
To achieve the above objectives, extensive trainings are being conducted at all levels of medicalpersonnel including administrators, Doctors, Nurses, Para-medical Staff, Waste handlers and CTFoperators. Trainings manuals and SOPs developed in 7 languages with pictorial representations forready understanding is anticipated to enable even the root level workers and feebly educated class toreadily understand the medical waste management protocols and practices; thereby helping inpercolation of the knowledge to the lowest stratum and upshot of effective implementation of New BMWRules, 2016.
As a part of project sub-contract, the training documents and SOPs has been developed Dept. ofCommunity Medicines, M. S. Ramaiah Medical College in consultation with the MoEFCC, UNIDO,Central Pollution Control Board (CPCB) and the experts from Technical Working Group and SteeringCommittee of the project appointed by MoEFCC. These documents are first of its kind and use of thesedocuments are recommended for a more strengthened management of BMW with community of skilledmanpower capable of replicating the knowledge further down the line.
The above objectives when accomplished will involuntarily help achieving the primecommitments of a) reduction and ultimate elimination of releases of Unintentionally Produced PersistentOrganic Pollutants (UP-POPs) under Stockholm Convention and b) ground level implementation of theBiomedical Waste Management Rules ,2016.
I congratulate M. S. Ramaiah Medical College for their endeavour in developing the trainingdocuments and SOPs and recommend the use of these documents for ESM of BMW.
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GOVERNMENT OF INDIA
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FOREWORD
UNITED NAT IONS INDUSTRIAL DEVELOPMENT ORGANIZATION
Regional Office in India
UN House, 55 Lodi Estate, New Delhi 110003 Tel: +91 11 24643484 Fax: +91 11 24620913 Email: office.india@unido.org; Website: www.unido.org
The United Nations Industrial Development Organization (UNIDO) is mandated to promote and facilitate industrial development for poverty reduction, inclusive globalization and environmental sustainability. This is embedded in the 2030 Agenda for Sustainable Development, the transformative agenda towards the future we want, unanimously agreed upon by the leaders of 193 Member States of the United Nations in 2015. In particular, its Sustainable Development Goal (SDG) 9, calls to “build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation”.
Equally, the 2013 Agenda targets good health and well-being, under SDG3 “ensure healthy lives and promote well-being for all at all ages”. Amongst others, this requires access to modern health services, provided in hospitals and other health care facilities, that as a consequence of their activities, produce a variety of wastes. These wastes need to be managed properly from source, through collection and transport to final treatment and disposal, to avoid posing threats to health and wellbeing, directly, due to infectious and/or toxic nature, or, indirectly, through the unintended creation of hazardous substances from incorrect treatment, particularly burning. The Stockholm Convention on Persistent Organic Pollutants and the Minamata Convention on Mercury, multilateral environmental agreements ratified by India, amongst others apply to the management of health care waste. UNIDO therefore implements a project with support from the Global Environment Facility (GEF) to develop scalable and replicable models for environmentally sound management of health care waste for different types of health care facilities, and demonstrate these in collaboration with hospitals across five States (Gujarat, Karnataka, Maharashtra, Odisha and Punjab).
Environmentally sound management of heath care waste starts with awareness of risks and adherence to standard operating practices by medical, nursing, administrative and general staff at all levels in the institutions. The M S Ramaiha Medical College and Hospitals in Bangalore therefore developed this set of training manuals and accompanying set of Standard Operating Practices. These are fully consistent with the National Bio-Medical Waste Management Rules of 2016. The Ministry of Environment, Forests and Climate Change (MoEFCC), Ministry of Health and Family Welfare (MoHFW), Central Pollution Control Board (CPCB) and other members of the Technical Advisory Committee all contributed to the review of these manuals.
I am pleased to recommend these manuals as the basis for practical and hands-on training for all involved in the health care waste management chain. Doing so will certainly contribute to protecting health and well-being of patients, staff, visitors and community at large, whilst also protecting the environment in a cost-effective manner.
René Van Berkel, PhD UNIDO Representative UNIDO Regional Office in India
Table of Contents
List of Abbreviations ................................................................................................................................. 1
Introduction .............................................................................................................................................. 2
Salient Features of BMWM Rules ............................................................................................................ 5
Objectives of Training ............................................................................................................................. 20
Overview of Training ............................................................................................................................... 21
One day Training Schedule (Sample Schedule) ....................................................................................... 22
Training of Trainers (TOT) Schedule ........................................................................................................ 23
Training of Waste Handlers..................................................................................................................... 24
Roles and Responsibilities of a Facilitator ............................................................................................... 25
Preparation for Training .......................................................................................................................... 26
Micro plan for each session of training programme............................................................................... 27
Reporting of the training programme..................................................................................................... 32
Tips for Training ...................................................................................................................................... 33
Bibliography ............................................................................................................................................ 35
Annexure-1 Pre-test and Post-test Questionnaire................................................................................. 36
Annexure-2 Keys for the pre and post test ........................................................................................... 40
Annexure-3 Waste Handler’s Evaluation Tool ...................................................................................... 41
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List of Abbreviations
BAT Best Available Technology BEP Best Environmental Practices BMW Bio Medical Waste CBWTF Common Biomedical waste treatment facility CPCB Central Pollution Control Board DLMC District Level Monitoring Committee ESM Environmentally Sound Management ESMMWI Environmentally Sound Management of Medical Wastes in India GEF Global Environment Facility GOI Government of India HCFs Health Care Facilities HCW Healthcare Waste HCWM Healthcare Waste Management Hg Mercury HICC Hospital Infection Control Committee HIV Human Immunodeficiency Virus HWTSDF Hazardous Waste Treatment Storage & Disposal Facilities IMA Indian Medical Association MoEFCC Ministry of Environment, Forest and Climate Change MOU Memorandum of Understanding MSRMC M.S.Ramaiah Medical College NACO National AIDS Control Organisation NGO Non-Governmental Organisation NSC National Steering Committee PCC Pollution Control Committee PCDD Polychlorinated dibenzo dioxins (Dioxins) PCDF Polychlorinated dibenzofurans (Furans) PEP Post Exposure Prophylaxis POPs Persistent Organic Pollutants PPE Personal Protective Equipment PPP Public Private Partnership SOP Standard Operating Procedure SNO State Nodal Officer SPCB State Pollution Control Board TNA Training Need Assessment ToTs Training of Trainers UNIDO United Nations Industrial Development Organization WHO World Health Organization
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Introduction
About the ESMMWI project:
India being signatory to Stockholm convention in 2002, measures to reduce POPs need to be
taken by the Government of India. One of the sources of unintentional production of POPs is
biomedical waste and in this context, project “Environmentally Sound Management of Medical
Wastes in India” (ESMMWI) was approved by Global Environment Facility (GEF) for which
United Nations Industrial Development Organization (UNIDO) is the implementing agency; and
Ministry of Environment Forest & Climate Change, Government of India is the national
executing agency. This project aims at reducing POPs by instituting sound biomedical waste
management.
This ESMMWI project will promote country-wide adoption of the best available technique
(BAT)/ best environmental practices (BEP) in health care facilities of widely differing complexity
and size, as well as in the evolving biomedical waste management infrastructure and industry in
a manner that protects human health and reduce adverse environmental health impacts.
The overall project objective will be achieved by covering but not limited to the following
approaches: 1
Segregation, decontamination and compaction of the medical wastes and thus reducing its
volume to be disposed off by introducing alternative technologies
Enhancing and optimizing incineration technologies
Awareness generation and dissemination of know-how
Incorporation of management systems
Innovation and adoption of appropriate and affordable technologies and techniques
Introduction of participatory funding systems and enhancement of relevant existing laws
and regulations
The project will create a unique opportunity for the healthcare providers, hospitals, health
departments, State Pollution Control Board (SPCB) and CBWTFs operators respectively to come
together on a single platform to create an enabling health care environment.
The PPP model envisaged at the district level will involve all concerned stakeholders and inter-
sectoral coordination where the community members, health care providers, state government
departments, monitoring and evaluation entities will come together with well-defined roles and
responsibilities for creation of a demonstration/model district of integrated biomedical waste
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management model. There will be one such model district in each of the 5 participating states
(Gujarat, Maharashtra, Karnataka, Odisha and Punjab), so as to achieve health and
environmental benefits and replicate the outputs and lessons learned in these regions.
In these model districts, the project will identify possible options for sound management of
biomedical waste by introducing non-burn alternative technologies or upgrading the existing
incinerators so as to implement BAT/ BEP.
To familiarize health professionals with new and alternative technologies and to adopt changes
in management, capacity building will be carried out for healthcare personnel. Awareness
generation in the community, infrastructural and equipment support for HCFs and CBWTFs will
be carried out.
About the training component of the ESMMWI Project:
The Training component of the project “Environmentally Sound Management of Medical
Wastes in India” has been awarded to M.S.Ramaiah Medical College, Bangalore.
The aim of the training component of the project is:
Enhance the existing institutional and technical capacity in identified 28 health-care
facilities in each of the 5 selected states.
Enhance the effectiveness and efficiency of segregation of biomedical wastes at source
which reduces the volume of biomedical waste and hence, improves the management
of waste at CBWTF.
Develop standard protocols for biomedical waste movement in healthcare facilities from
source to collection points established.
Establish an integrated system for biomedical waste management and disposal.
The major components of the project is:
Training Need Assessment
Development of Training Documents, Guidance Manuals and Awareness Campaign
Materials on Biomedical Waste Management
Implementation of Training Programmes on Biomedical Waste Management
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About the training Manuals and SOPs
The following documents have been developed to aid in the training process
i. Trainer’s guide – provide guidelines for conducting one-day training on issues of
environmentally sound management of Biomedical waste. It would help facilitators
communicate the information present in the Training Manual for Doctors, Nurses and
Waste handlers on Biomedical Waste Management using interactive training
techniques.
ii. Information handbook on BMWM for Administrators- deals with the administrative
aspects of biomedical waste management, for example: steps to set up a Biomedical
waste management system in a HCF, policy issues, monitoring and issues regarding
occupational safety, role and responsibilities of personnel involved in Biomedical waste
management.
iii. Training Manual on BMWM for Doctors and Nurses deals with processes involved in
waste management such as segregation, disinfection, transportation, documentation
and methods of final disposal. It gives an overview of the processes involved in waste
management in a health care setting.
iv. Training Manual for waste handlers deals with practical aspects and has pictorial
representation of the processes. This would aid in the training of waste handlers who
may have lower level of literacy
v. Standard Operating Procedures - Biomedical waste management has to be process
dependent and not person dependent. The Standard Operating Procedure (SOP) will
help in uniform implementation of the processes for Biomedical waste Management
Rules, 2016. SOPs represent the action plan for achieving the policy.
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Salient Features of BMWM Rules
1. Introduction:
Waste management rules in India are founded on the principles of “sustainable
development”, “precaution” and “polluter pays”. Various rules were framed under the
broader umbrella of “Environment Protection Act’ by Ministry of Environment and Forests
(MoEFCC) in 19862.
2. Key principles governing safe management of BMW: 3,4,5
2a. “Sustainable development” is the organizing principle for sustaining finite resources
necessary to provide for the needs of future generations of life on the planet
2b. The “Polluter Pays” Principle– Section 9 (3) of the Act embodies the “Polluter Pays
Principle” which states that any expense which has been incurred to restore the
environment to its natural state shall be paid by the person who is responsible for such
degradation. ”Polluter must bear the cost for damages and harm caused to environment
by his own acts.
2c. The “Precautionary principle” – states that when the magnitude of a particular risk is
uncertain, it should be assumed that this risk is significant and all measures should be
taken to protect health and to avoid environmental degradation and hazards.
2d. The “Duty of Care Principle” refers that it is an obligation for any individual to follow utmost
care while performing any tasks that could foreseeably harm others. It stipulates that any
person handling or managing hazardous substances or related equipment is ethically
responsible for using the utmost care in that task.
2e. The “Proximity Principle” recommends that treatment and disposal of hazardous waste
take place at the closest possible location to its source in order to minimize the risks
involved during its transportation
2f. The “Prior Informed Consent Principle” as embodied in various international treaties
requires that affected communities and other stakeholders be apprised of the hazards
and risks, and that their consent be obtained. In the context of BMW, the principle could
apply to the transport of biomedical waste and the siting and operation of biomedical
waste-treatment and disposal facilities.
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3. Important Milestones
3a. International laws:
i. Basel Convention- Convention on the Control of Transboundary Movements of
Hazardous Wastes and their Disposal, 19896
ii. Stockholm Convention- Stockholm Convention on Persistent Organic
Pollutants Stockholm, 20017
iii. Minamata Convention- on Mercury, Minamata 20138
3b. Indian laws :
i. Environment (Protection) Act, 1986
ii. Batteries (Management and Handling) Rules, 2001
iii. Plastic Waste Management Rules, 2016
iv. E-waste (Management) Rules, 2016
v. Biomedical Waste Management Rules, 2016
vi. Hazardous and Other Wastes (Management and Transboundary Movement) Rules,
2016
vii. Solid Waste Management Rules, 2016
viii. Bio-Medical Waste Management (Amendment) Rules, 2018
4. Biomedical Waste Management Rules, 2016 and BMWM (Amendment)
Rules 20182
4a. Introduction: Under the Environment (Protection) Act, 1986, Biomedical waste
Management Rules, 2016 came into force from 28th March 2016 in superseding of the
earlier Biomedical Waste (Management and Handling) Rules, 1998. Amendments to
BMWM Rules 2016 was notified via Gazette notification on 16th March 2018 as
Biomedical Waste Management (Amendments) Rules, 2018.
4b. Application: The rules apply to all persons who generate, collect, receive, store,
transport, treat, dispose or handle biomedical waste in any form including
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Hospitals
Nursing homes
Clinics
Dispensaries
AYUSH Hospitals
Veterinary institutions/ Hospitals
Animal houses
Pathological laboratories
Blood banks
Clinical establishment research or educational institutions
Forensic laboratories
Research labs
Health camps
Medical/surgical/OBG camps
Vaccination camps
Blood donation camps
First aid rooms of schools
4c. BMWM Rules, 2016 shall not apply to 2
Sl. No.
Type of waste Covered under
i. Radioactive waste Atomic Energy At, 1962 (33 of 1962)
ii. Hazardous Chemicals Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989
iii. Solid Wastes Solid waste Management Rules, 2016
iv. The Lead Acid Batteries Batteries (Management and Handling) Rules, 2001
v. Hazardous Wastes Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2016
vi. E- Waste E- Waste ( Management and Handling Rules, 2016 made under the act
vii. Hazardous Microorganisms Genetically Engineered Microorganisms and Cells
Manufacture, Use, Import, Export and Storage of Hazardous Microorganism, Genetically Engineered Microorganisms or Cells Rules, 1989
5. Important definitions2:
5a. "act" means the Environment (Protection) Act, 1986 (29 of 1986)
5b. "animal house" means a place where animals are reared or kept for the purpose of
experiments or testing; "authorization" means permission granted by the prescribed
authority for the generation, collection, reception, storage, transportation, treatment,
processing, disposal or any other form of handling of Biomedical waste in accordance with
these rules and guidelines issued by the Central Government or CPCB as the case may be;
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5c. "authorized person" means an occupier or operator authorized by the prescribed
authority to generate, collect, receive, store, transport, treat, process, dispose or handle
Biomedical waste in accordance with these rules and the guidelines issued by the Central
Government or the Central Pollution Control Board, as the case may be
5d. "biological" means any preparation made from organisms or micro-organisms or
product of metabolism and biochemical reactions intended for use in the diagnosis,
immunization or the treatment of human beings or animals or in research activities
pertaining thereto;
5e. "Biomedical waste" means any waste, which is generated during the diagnosis,
treatment or immunization of human beings or animals or research activities pertaining
thereto or in the production or testing of biological or in health camps, including the
categories mentioned in Schedule I appended to the rules
5f. "Biomedical waste treatment and disposal facility" means any facility wherein
treatment, disposal of Biomedical waste or processes incidental to such treatment and
disposal is carried out, and includes common Biomedical waste treatment facilities
5g. “Form” means the Form appended to these rules
5h. “handling” in relation to Biomedical waste includes the generation, sorting, segregation,
collection, use, storage, packaging, loading, transportation, unloading, processing,
treatment, destruction, conversion, or offering for sale, transfer, disposal of such waste
5i. “health care facility” means a place where diagnosis, treatment or immunization of
human beings or animals is provided irrespective of type and size of health treatment
system, and research activity pertaining thereto;
5j. “major accident” means accident occurring while handling of Biomedical waste having
potential to affect large masses of public and includes toppling of the truck carrying
Biomedical waste, accidental release of Biomedical waste in any water body but exclude
accidents like needle prick injuries, mercury spills
5k. “management” includes all steps required to ensure that bio- medical waste is managed
in such a manner as to protect health and environment against any adverse effects due to
handling of such waste;
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5l. "occupier" means a person having administrative control over the institution and the
premises generating biomedical waste, which includes a hospital, nursing home, clinic,
dispensary, veterinary institution, animal house, pathological laboratory, blood bank, health
care facility and clinical establishment, irrespective of their system of medicine and by
whatever name they are called
5m. "operator of a common Biomedical waste treatment facility" means a person who
owns or controls a Common Biomedical Waste Treatment Facility (CBMWTF) for the
collection, reception, storage, transport, treatment, disposal or any other form of handling
of Biomedical waste
5n. “prescribed authority” means the State Pollution Control Board in respect of a State
and Pollution Control Committees in respect of an Union territory;
5o. "Schedule" means the Schedule appended to these rules.
6. Duties of the Occupier: 2 It shall be the duty of every occupier to-
a. take all necessary steps to ensure that Biomedical waste is handled without any
adverse effect to human health and the environment and in accordance with these
rules;
b. make a provision within the premises for a safe, ventilated and secured location for
storage of segregated biomedical waste in colored bags or containers in the manner as
specified in Schedule I
c. pre-treat the laboratory waste, microbiological waste, blood samples and blood bags
through disinfection or sterilization on-site in the manner as prescribed by the WHO
guidelines on Safe management of wastes from health care activities and WHO Blue
Book, 2014 and then sent to the Common bio-medical waste treatment facility for final
disposal;
d. phase out use of chlorinated plastic bags (excluding blood bags) and gloves within two
years by 27th Match 2019;
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e. dispose of solid waste other than Biomedical waste in accordance with the provisions of
respective waste management rules made under the relevant laws and amended from
time to time;
f. not to give treated Biomedical waste with municipal solid waste;
g. provide training to all its health care workers and others, involved in handling of bio
medical waste at the time of induction and thereafter at least once every year and the
details of training programmes conducted, number of personnel trained and number of
personnel not undergone any training shall be provided in the Annual Report;
h. immunize all its health care workers and others, involved in handling of Biomedical
waste for protection against diseases including Hepatitis B and Tetanus that are likely to
be transmitted by handling of Biomedical waste, in the manner as prescribed in the
National Immunization Policy or the guidelines of the Ministry of Health and Family
Welfare issued from time to time;
i. establish a Bar- Code System for bags or containers containing Biomedical waste to be
sent out of the premises or for the further treatment and disposal in accordance with
the guidelines issued by the Central Pollution Control Board by 27th March, 2019;
j. ensure segregation of liquid chemical waste at source and ensure pre-treatment or
neutralization prior to mixing with other effluent generated from health care facilities;
k. ensure treatment and disposal of liquid waste in accordance with the Water
(Prevention and Control of Pollution) Act, 1974 ( 6 of 1974);
l. ensure occupational safety of all its health care workers and others involved in
handling of Biomedical waste by providing appropriate and adequate personal
protective equipment;
m. conduct health check up at the time of induction and at least once in a year for all its
health care workers and others involved in handling of bio- medical waste and maintain
the records for the same;
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n. maintain and update on day to day basis the Biomedical waste management register
and display the monthly record on its website according to the Biomedical waste
generated in terms of category and color coding as specified in Schedule I;
o. report major accidents including accidents caused by fire hazards, blasts during
handling of Biomedical waste and the remedial action taken and the records relevant
thereto, (including nil report) in Form I to the prescribed authority and also along with
the annual report;
p. all the health care facilities (any number of beds) shall make available the annual report
on its web-site within a period of two years from the date of publication of Bio-Medical
Waste Management (Amendment) Rules, 2018;
q. inform the prescribed authority immediately in case the operator of a facility does not
collect the Biomedical waste within the intended time or as per the agreed time;
r. establish a system to review and monitor the activities related to Biomedical waste
management, either through an existing committee or by forming a new committee and
the Committee shall meet once in every six months with documentation of the minutes
of meeting. HCFS with less than 30 bedded hospitals to designate a person to monitor
and review the activities of BMWM and submit an annual report.
7. Salient features of BMW Management Rules, 2016 and amendments of
2018 include the following9:
a. The ambit of the rules has been expanded to include camps such as vaccination camps,
blood donation camps, surgical camps or any other healthcare activity
b. Phase out use of chlorinated plastic bags (excluding blood bags) and gloves within two
years by 27th Match 2019
c. Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags
through disinfection or sterilization on-site in the manner as prescribed by the WHO
guidelines on Safe management of wastes from health care activities and WHO Blue
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Book, 2014 and then sent to the Common bio-medical waste treatment facility for final
disposal
d. Provide training to all its health care workers and immunize all health workers regularly
e. Establish a Bar- Code System for bags or containers containing Biomedical waste to be
sent out of the premises or for the further treatment and disposal in accordance with
the guidelines issued by the Central Pollution Control Board by 27th March, 2019
f. Report major accidents
g. The new rules prescribe more stringent standards in existing incinerators for
incinerator to reduce the emission of pollutants in environment
h. Inclusion of emissions limits for Dioxin and furans
i. Achieve the standards for retention time in secondary chamber and Dioxin and Furans
within two years
j. Biomedical waste has been classified in to 4 categories instead 10 to improve the
segregation of waste at source
k. Procedure to get authorization simplified. Automatic authorization for bedded
hospitals. The validity of authorization synchronized with validity of consent orders for
bedded HCFs. One time authorization for non-bedded HCFs
l. State Government to provide land for setting up common Biomedical waste treatment
and disposal facility
m. No occupier shall establish on-site treatment and disposal facility, if a service of
`common biomedical waste treatment facility is available at a distance of seventy-five
kilometer.
n. Operator of a common biomedical waste treatment and disposal facility to ensure
the timely collection of biomedical waste from the HCFs and assist the HCFs in conduct
of training.
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8. Major provisions in the Bio- Medical Waste Management Rules, 2016 and its likely
implication 10
BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
Title
Bio- Medical Waste (Management and Handling) Rules, 2011
Bio- Medical Waste Management Rules, 2016.
Biomedical Waste Management (Amendment) Rules 2018
The word ‘Management’ includes Handling.
Application
These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle biomedical waste in any form.
These rules shall apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form and shall not apply to:
- Radioactive waste
- Municipal solid waste
- Lead acid batteries
- Hazardous waste
- E-waste
- Hazardous microorganisms
Modified to bring more clarity in the application.
Clarified that vaccination camps, blood donation camps, surgical camps or any other healthcare activity undertaken outside the healthcare facility, will be covered.
Duties of the Health care facilities including CBWTF
Every occupier of an institution generating bio-medical waste which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank to take all steps to ensure that
Additions:
Health care facilities (HCF)
shall make a provision within
the premises for a safe,
ventilated and secured
location for storage of
segregated biomedical waste
To ensure that there shall be no secondary handling, pilferage of recyclables or inadvertent scattering or spillage by animals and the BMW from such place or premises can be directly transported in to the CBWTF
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BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
such waste is handled without any adverse effect to human health and the environment.
Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilization on-site in the manner as prescribed by the WHO guidelines on Safe management of wastes from health care activities and WHO Blue Book, 2014 and then sent to the Common bio-medical waste treatment facility for final disposal;
This is to prevent the possible microbial contamination.
Phase out use of chlorinated plastic bags (excluding blood bags) and gloves within two years by 27th Match 2019
Will eliminate the emission of dioxin and furans from burning of such wastes.
Provide training to all its health care workers and others involved in handling of BMW at the time of induction and thereafter at least once every year
Will improve the management of BMW including collection, segregation.
Immunise all its health care workers and others involved in handling of BMW for protection against diseases including Hepatitis B and Tetanus
To protect the health of workers
Establish a Bar- Code System for bags or containers containing Biomedical waste to be sent out of the premises or for the further treatment and disposal in accordance with the guidelines issued by the Central Pollution Control
Will improve the segregation, transportation and disposal system. Also will eliminate pilferage on the way of BMW to disposal facility.
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BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
Board by 27th March, 2019
Report all major accidents including accidents caused by fire hazards, blasts during handling of BMW and the remedial action taken to SPCB
Help to monitor and improve the management
Existing incinerators shall achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years from the date of this notification
Will improve the environment in the vicinity of treatment facility.
Duties of the operator of a CBWTF
Nil Same as the duties of HCFs and additionally they shall ensure timely collection of bio-medical waste from the HCFs, assist the HCFs in conduct of training
Specific responsibility on the operator of a common bio-medical waste treatment and disposal facility will be make them clear to their duties
Treatment and disposal
Every HCFs, where required, shall set requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure requisite
No occupier shall establish on-site treatment and disposal facility, if a service of CBWTF is available within a distance of seventy-five kilometer.
This is to make the installation and operation of CBWTF a viable one.
Segregation
Bio-medical waste classified in to 10 categories based on treatment options.
Bio-medical waste classified in to 4 categories based on treatment options.
Will improve the segregation of waste at source channelize proper treatment and disposal
Storage
No untreated bio-medical waste shall be kept stored
Untreated human anatomical waste, animal anatomical
Will eliminate obtaining permission within 48 hours
16 | P a g e
BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
beyond a period of 48 hours. Provided that if for any reason it becomes necessary to store the waste beyond such period, the authorised person must take permission of the prescribed authority and take measures to ensure that the waste does not adversely affect human health and the environment.
waste, soiled waste and, biotechnology waste shall not be stored beyond a period of 48 hours. In case for any reason it becomes necessary to store such waste beyond such a period, the occupier shall take appropriate measures to ensure that the waste does not adversely affect human health and the environment and inform the SPCB along with the reasons.
which is not practically feasible.
Authorisation
Hospitals treating 1000 or more patients per month to obtain authorization from SPCBs/PCCs
One time Authorisation for Non-bedded HCFs. The validity of authorization shall be synchronised with validity of consent orders for Bedded HCFs
HCFs can make application along with consent and hence getting authorisation will not be additional burden for HCFs. and operator of treatment facility. It will also help to SPCB in making single inspection / monitoring to consider both the consent and authorisation.
Advisory committee
The Government of every State/Union Territory shall constitute an advisory committee with the experts in the field of medical and health, animal husbandry and veterinary sciences, environmental management, municipal administration, and any other related department or organisation including non-
No change in the concept except additional members. Shall meet once in six months.
Advisory Committee has strengthened suitably with additional members.
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BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
governmental organisations. Ministry of Defence shall constitute, an Advisory Committee under Additional Director General of Armed Forces Medical Services with representative of Ministry of Defence, MoEFCC, for HCFs under Armed forces under the Ministry of Defence.
Standards for emission from incinerators
SPM in the Incinerator’s emission- 150 mg/Nm3
50 mg/Nm3 The proposed stringent standards for emission from Incinerator (reduction of permissible limit for particulate matter, introduction of standards for Dioxin and Furans and increasing the residence time in the Incinerator Chambers) will improve the operation of incinerator and reduce the emission of pollutants in environment.
Residence Time in Secondary chamber of incinerators is 1 second
2 seconds
Nil - Standards for Dioxin and furans
Standards for Dioxin and furans prescribed.
Site for Common bio-medical waste treatment and disposal facility
--Nil.. The department dealing the allocation of land shall be responsible for providing suitable site for setting up of CBWTF in the State Government
Getting suitable land is the problem in many States for establishment of CBWTF. Making the responsibility of state Government to provide land would eliminate the issue of getting land for the CBWTF.
Monitoring of implementation
..Nil.. MOEFCC shall review the implementation of the rules in the country once in a year
The monitoring of the implementation was earlier only with SPCBs and review of
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BMW (Management and
Handling) Rules, 1998 &
revised in 2011
Bio- Medical Waste
Management Rules, 2016 and
Amendments, 2018
Reasons and likely implications
through the State Health Secretaries and CPCB,SPCBs State Government shall constitute District Level Monitoring Committee (DLMC) under the chairmanship of District Collector or District Magistrate or Deputy Commissioner or Additional District Magistrate to monitor the compliance of the provisions of these rules in the HCF. DLMC shall submit its report once in six months to the State Advisory Committee, SPCB for taking further necessary action. DLMC shall comprise of District Medical Officer or District Health Officer, representatives from SPCB, Public Health Engineering Department, local bodies or municipal corporation, IMA, CBWTF, registered NGO working in the field of BMW management. District Medical Officer shall be the Member Secretary of this Committee.
implementation through the District Committee is likely to improve the implementations.
Source: Major changes in BMWM rules 2016. Available at
http://pibphoto.nic.in/documents/rlink/2016/mar/p201632701.pdf accessed on 25th Dec 2017
9. Schedule 2
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Schedule Details
Schedule I Biomedical waste categories and their segregation, collection, treatment,
processing and disposal options
Schedule II 1. Standards for incinerators
a. Operating standards
b. Emission standards
c. Stack Height
2. Operating and Emission standards for disposal by Plasma pyrolysis
or Gasification:
a. Operating standards
b. Air emission standards and air pollution control measures
c. Disposal of ash vitrified materials
3. Standards for autoclaving of biomedical waste
4. Standards for Microwaving
5. Standards for Deep Burial
6. Standards for efficacy of Chemical Disinfection
7. Standards for dry heat sterilization
8. Standards for Liquid waste
Schedule III List of Prescribed Authorities and the corresponding duties
Schedule IV Part A Label for biomedical waste containers or bags
Schedule IV Part B Label for transporting biomedical waste bags or containers
According to BMWM Rules 2016, under the duty of occupier rule 4(g), report of training of all
the personnel involved in bio medical waste management is necessary. The details of the
personnel trained has to be reported to the respective Pollution Control Boards.
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Objectives of Training
The main objective of training is to strengthen the knowledge, attitude and skill of the
personnel handling Biomedical waste management (BMWM) in various capacities as
administrators, doctors, nurses & waste handlers in health care facilities across the five
identified states (Gujarat, Karnataka, Maharashtra, Odisha and Punjab) of the country.
The following objectives should be kept in mind for training of various personnel involved in
BMW management:
1. Administrators, waste mangers and CBWTF managers
Understand the importance of Environmentally Sound Management of BMW
Have an overview of the BMWM Rules, 2016
Comprehend processes involved in BMWM
Identify gaps in BMWM in their respective health care facilities
Prepare implementation plans for improvising the system of BMWM in their
respective HCFs and develop as a model HCF
Prepare plans for conduct of training in their respective health care facilities of all
the personnel involved in management of bio medical waste.
Set up/ improvise BMWM systems in their respective HCF
Identify and delineate role of each of the personnel involved in BMWM
Develop monitoring plans in their respective health care facilities
2. Health Care professionals
Understand the importance of Sound management of Biomedical Waste.
Have an overview of the BMWM Rules, 2016
Prepare plans for conduct of training in their respective health care facilities of all
the personnel involved in management of bio medical waste.
Train personnel in their respective health care facilities.
Set up/ improvise biomedical waste management systems in their respective HCFs
Develop monitoring plans in their respective HCFs
3. Waste handlers
Understand the importance of using PPE and immunization to protect themselves.
Know about segregation, storage and transportation.
Comprehend the processes involved in BMWM
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Overview of Training
Duration of training One day
Number of participants 30 – 35 maximum of 40 participants
Background of the trainers/ facilitators Preferably Doctors / Nurses/ waste management officer who have undergone training in Bio medical waste management
Facilitators Two locally identified facilitators, one from MSRMC, Assistant State project officer and one from state pollution control board.
Venue At health care facility
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One day Training Schedule (Sample Schedule)
One day training schedule in selected Health care facility
Note: Any additional issues can be discussed and incorporated based on the need *Action plan can be discussed based on need of the Health care facility
Time Duration Session Method
9.00 am – 9.30 am 30 minutes Registration
9.30 am – 10.00 am 30 minutes Inauguration
10. 00 am– 10.30 am 30 minutes Pre-test About the project, Objectives and expected outcomes
Presentation
10.30 am – 10.45 am 15 minutes Ice breaking session, participants view and expectations
Brainstorming, discussion
10.45 am -11.00am 15 minutes Tea break
11.00 am – 11.15 am 15 minutes Situation analysis of BMW in the HCF Presentation
11.15 am – 11.45 pm 30 minutes Introduction to HCWM – importance, definition, types of waste, life cycle approach
Discussion, brainstorming
11.45 am – 12.15 pm 30 minutes BMWM Rules, 2016 Discussion
12.15pm – 1.00pm 45 minutes Segregation of waste and containment Segregation , discussion
Exercise on segregation Demonstration & Exercise
01.00 -2.00 pm 60 minutes Lunch
02.00- 2.30 pm 30 minutes Pre-treatment by autoclaving/microwaving or chemical disinfection
& chemical liquid waste management
Demonstration & video, Interactive discussion
02.30 pm – 03.00 pm 30 minutes Spill management Blood &Body fluid Mercury Chemical Cytotoxic
Interactive Discussion Video film
03.00 pm – 03.30 pm 30 minutes Final treatment options Interactive session
03.30 pm – 03.45 pm 15 minutes Tea Break
03.45 pm – 04.15 pm 30 minutes Occupational safety Demonstration & Discussion
04.15 pm – 04.45 pm 30 minutes Monitoring & Evaluation;Documentation
Action plan *
Group discussion
4.45- 5 PM 15 minutes Valedictory & Certificate distribution
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Training of Trainers (TOT) Schedule
Training of Trainers (TOT) workshop (Two days)
Day 1
Time Duration Session Method
9.00 – 9.30 am 30 minutes Registration
9.30- 10.00 am 30 minutes Inauguration
10.00 – 10.30 am 30 minutes Pre-test , About the project, Objectives and expected outcomes
Presentation
10.30 am – 10.45 am 15 minutes Ice breaking session, participants view and expectations
Brainstorming, discussion
10.45 am -11.00am 15 minutes Tea break
11.00 am – 11.15 am 15 minutes Situation analysis of BMW in the HCF Presentation
11.15 am – 11.45 pm 30 minutes Introduction to HCWM – importance, definition, types of waste, life cycle approach
Discussion, brainstorming
11.45 am – 12.15 pm 30 minutes BMWM Rules, 2016 Discussion
12.15pm – 1.00pm 45 minutes Segregation of waste and containment Segregation , discussion
Exercise on segregation Demonstration & Exercise
01.00 -2.00 pm 60 minutes LUNCH
02.00- 2.30 pm 30 minutes Pre-treatment by
autoclaving/microwaving or chemical disinfection
& chemical liquid waste management
Demonstration & video, Interactive discussion
02.30 pm – 03.00 pm 30 minutes Spill management Blood &Body fluid Mercury Chemical Cytotoxic
Interactive Discussion Video film
03.00 pm – 03.30 pm 30 minutes Final treatment options Interactive session
03.30 pm – 03.45 pm 15 minutes Tea Break
03.45 pm – 04.15 pm 30 minutes Occupational safety Demonstration & Discussion
04.15 pm – 04.45 pm 30 minutes Preparation for the field visit and evaluation of the day
Discussion
24 | P a g e
Day 2
Training of Waste Handlers
Points to consider when imparting training to waste handlers:
Training, preferably conducted in the local vernacular language
Less of didactic and more of interaction and demonstration
More of AV aids to be used . Ex Video film, flip charts, posters and demonstrations
Importance of PPE has to be emphasized
Adult learning principles need to be applied when conducting training
It is suggested that duration of training for waste handlers be restricted to half a daysession
Waste handlers need to be trained, on issues of segregation, disinfection, transportationand use of PPE
Doctors/ nurses/ waste management officer can train the waste handlers in the localvernacular language
Training and retraining of waste handlers is necessary as the turnover rate of wastehandlers is high
For further details refer Waste Handlers Manual
Time Duration Session Method
08.30 am – 01.00 pm 4 hours and 30 minutes
Visit to model facility- HCF and CBWTF Demonstration, Discussion
01.00 -2.00 pm LUNCH
02.00- 2.30 pm 30 minutes Debriefing, monitoring and evaluation Group discussion
02.30 pm – 03.00 pm 30 minutes Action plan discussion Group work
03.00 pm – 03.15 pm Tea break
03.15 pm – 03.45 pm 30 minutes Presentation of action plan, training logistics
Group work presentation
03.45 pm – 04.00 pm 15 minutes Post-test, Participants feedback Brainstorming
04.00 pm – 04.30 pm 30 minutes Valedictory (Certificate distribution, any 2 participants speak) in additional to other plans.
Distribution of certificates and conclusion
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Roles and Responsibilities of a Facilitator
Guidance 11,12
State the training objectives of each session in order to initiate discussion
Sessions to be made as interactive as possible
Clarify any doubts
Be available and ready to help
Provide examples from own experience
Possess good communication skills speak clearly and modulate voice
Ask a participant to summarize at the end of each session, fill in the gaps if need be.
Use different methodology of facilitation depending on audience (Example more
pictorial and participatory for waste handlers, interactive sessions for doctors and
nurses etc.)
Motivation 11,12
Compliment the participants for their active involvement
Ensure participation of each of the participants in the training
Keep the group on track
Offer constructive criticism
Ensure an atmosphere that is conducive for learning , open and non-judgmental
Encourage suggestions from participants
Obtain feedback from participants so that further session can be improved upon
Ask one of the participant to recapitulate the learnings at the end of the sessions.
Organizational 11,12
Ensure that venue is comfortable and quiet
Ensure an atmosphere that is conducive for learning , open and non-judgmental
Ensure that all participants have access to all materials
Record conclusions and agreements
Set goals that are achievable
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Preparation for Training
ASPO will coordinate with the HCF for the finalization of date, venue and other logistics
arrangements. Preferably a meeting should be conducted prior to the training to delineate and
discuss content of presentation with the facilitators. Training programme would be smooth and
uneventful if the confirmations regarding date, participants, facilitators, venue, and other
logistics are sought few days prior to the programme. The below given checklist would aid in
the preparation for the training programme.
Checklist for state– UNIDO Training at respective HCF Sl. No. Checklist Remarks
1. Confirm date, Time and Venue
2. List of invitees
3. List of chief guests and their biodata
4. Registration forms–Print
5. Lighting lamp or other activity signifying inauguration
6. Bouquets/ Mementoes
7. Banners– Print
8. AV Aids- ( Laptop, LCD projector with white screen)
9. Files, note pads, pens, Sketch pens, Marker Pens
10. Attendance form– print
11. Resource persons- List, Invitation, TA/DA
12. Invite HCFs/ CBWTF
13. Identify HCF for demonstration
14. Identify CBWTF (model district) for visit
15. List of Participants and invitation
16. Food and refreshments
17. Certificates for participants & resource persons
18. Rapporteur
19. Pre & post- test forms printouts
20. Reporting formats
21. HONOs – Stay and transportation
22. Vouchers and bills
23. Demonstration at venue- Colour coded bins & Demo kits for segregation exercise
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Micro plan for each session of training programme
Planning for each of the sessions: (Time may be modified according to the need of the
resource person)
Time Activity/ Topic Methodology and steps Materials
30 min Registration Participants to fill the registrationformat
Distribute any material / handout
Make note of nominated participantswho have not attended
Registration format
30 min Inauguration Ensure the dignitaries are on time
prepare a schedule for inauguration
Mementoes, Bouquets, may be Culture specific based on the state
Time Activity/
Topic Objective Methodology Materials
20min Pretest To test the knowledge of the participants before the training
Distribute questionnaire toparticipants
Plot percentage of correctanswers
Identify weak areas withquestions with < 50 %correct answers
Pre test forms
15 min Ice breaking session
To get to know the participants better
Introduction of all the participants and facilitators.
10 min About the project, its objectives and expected outcomes
To appraise the participants
Regarding expectedoutcomes of thetraining programme
Regardingobjectives of theproject
Brief presentation ofobjectives and activitiesunder the project
Power point presentationfor the same to be ready
PPT for the same
15 min Situation analysis of BMW in the selected HCFs of the state
To appraise the participants of the present practices of health care waste management in their respective hospitals
A presentation of thesituation analysis of theselected HCF to be made bythe master trainer/administrator of thehospital.
The presentationpreferably must highlight
PPT presentation
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Time Activity/
Topic Objective Methodology Materials
the current practices of segregation, disinfection, management of sharps and any other best practices that are being followed in any of the 28 HCFs of the respective states. The final disposal mechanism also can be highlighted. Special mention of HCFs where CBWTF are not available.
15 min Tea Break
5 min Introduction to Bio Medical Waste management
To create awareness regarding advantages of sound management of Bio Medical waste
Impact on health and environment due to improper waste management.
By interaction with the participants
5min Definition To discuss definitions of commonly used terms
By interaction with participants, discuss definitions of commonly used terms such as Definitions of: Waste, bio medical waste, occupier, HCF, autoclave, microwave, disinfection, segregation, CBWTF etc.
Presentation PPT
10 min Life cycle approach
To appraise participants regarding the life cycle approach of BMWM
Discuss Life cycle approach with examples
Presentation
30 min BMWM Rules, 2016
Objective of the session: At the end of the session it is expected that participants would be aware of the new rules
Interactive discussion onchanges suggested in thenew rules
PPT
10 min Segregation and containment of waste
To discuss the importance of segregation and containment practices as per BMWM Rules, 2016
Discuss the importance ofsegregation, prerequisitesfor segregation andcontainment
Discuss color coding
Interactive discussion with the help of PPT
15min Exercise on Segregation
To demonstrate segregation in accordance with
Divide participants into 3- 4 groups Each participant is given one
Segregation sets and color coded bins
29 | P a g e
Time Activity/
Topic Objective Methodology Materials
BMWM Rules,2016 item to be put in the correct bin. Should be done without discussion. Discussion on segregation to be done after every 6 items are segregated
10 min Disinfection To discuss role of pre-
treatment by autoclaving/microwaving
and chemical
disinfection. in Bio Medical waste management
By interaction with the participants,
Discuss the importance ofpre-treatment by
autoclaving/microwaving
and chemical disinfection,
Difference betweendisinfection andsterilization, principles ofchemical disinfection
As per rules, the categoryof waste that requirespretreatment byautoclaving/ microwavingand chemical disinfection
As per BMWM Rules, 2016the prescribed chemicaldisinfection agents andtheir strength.
PPT and interactive session
10 min Chemical liquid waste management
To understand procedures to be undertaken for safe disposal of chemical liquid waste
By interaction with participants discuss the importance of safe disposal of chemical liquid waste and different methods for disposal of liquid chemical waste
PPT and interactive session
8 min Spill management:
To discuss the steps to be taken for management of spill.
Contents of a spill kit To demonstrate the management of spill of blood or body fluid
Demonstrate the contentsof a spill kit.
Demonstrate the steps ofspill management using thespill kit.
Contents of a spill Kit - Disinfection agents, Piece of cloth, Yellow liner Gloves, mask, goggles , apron , caution board
5 min Mercury waste management:
To highlight the importance of mercury contamination in health care facility and
By interaction, elicit thehazards of mercury
Elicit the current practicesin management of Mercury
PPT / Video film, Mercury spill kit,
30 | P a g e
Time Activity/
Topic Objective Methodology Materials
measures to phase out mercury in health care settings
in the hospitals
Demonstrate mercury spillmanagement
Two exposed x-ray films or Plastic film, Plastic or glass bottle with water, 20 ml syringe without needle, Nitrile glove
5min Video film on mercury spill management
To demonstrate right practice of managing mercury spill
To play video film and summarize key points
Video film
2 min Summary To summarize the important points
Recap of important points PPT
30 min Final treatment options
Objective of the session is: To discuss various technologies available for final disposal.
Interactive discussion
Discuss in brief theadvantages anddisadvantages of each ofthe technologies.
Discuss the importance ofsegregation in final disposalmechanisms.
Discuss specifically eachperson’s role in the chain ofevents.
PPT
6 min Occupational safety
To highlight importance of occupational safety in a health care setting
Discuss importance of occupational safety By interaction, elicit the various occupational hazards in a hospital
PPT
6 min PPE To demonstrate use of personal protective equipment
By interaction, elicit importance and list various activities in the hospital that require personal protective equipment
Demonstrate the various PPE
6 min Needle stick injury
To discuss importance of needle stick injury and management reporting
Discuss the consequences of needle stick injury and its prevention
PPT
6min Immunization To discuss importance of immunization among health care workers
Discuss the various mandatory immunizations in a health care sector
PPT
6 min Periodic To discuss importance Discuss the importance of PPT
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Time Activity/
Topic Objective Methodology Materials
health examination
of periodic health examination as a part of occupational safety
periodic health examination
30 min Debriefing,
monitoring and evaluation
To discuss importance of monitoring of the health care waste management.
Discussion with participants regarding the visit. Discussion on best practices and how it can be adapted to their facility
Flip chart to note down the points for implementation
15 min Posttest, participants feedback
To test knowledge of the participants after the training and
To evaluate training programme
Administration of Post-test to the participants Plot a graph similar to Pre test Compare the two Check if any of the questions have less than 50% correct answers. Check if the issue has been clarified.
Feedback form to be filled by the participants
Post-test forms, Session feedback forms
15 min Valedictory Certificate distribution and feedback from the participants.
Certificates Feedback forms
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Reporting of the training programme
Every training activity conducted needs to be reported using the reporting format.
The following aspects need to be taken into account for reporting
1. Executive summary
2. Introduction
3. Venue, date & timing of the training
4. Training team
5. Profile of trainees and number of trainers.
6. Inauguration details
7. Training sessions and discussion
8. Stakeholder Discussions (if any)
9. Conclusion/ way forward
10. Take home messages from training
11. Evaluation
12. Acknowledgement
13. Annexures (if any):
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Tips for Training
Adult learning Principles 11,12
Adult learners are motivated and self-directed
Adult learners bring life experience and knowledge
Adult learners are goal oriented
Adult learners are relevancy oriented
Adult learners are practical
Adult learners like to be respected
The teaching methodology should align with principles of adult learning
Adults will learn only when they are motivated to do so
They learn by doing and focus more on problem solving.
Any training programme focused on adults need to be flexible and must cater to theirneeds. It should be less directive and more of responsive
Adult learners draw heavily on their experience and relate present learning to previouslearning. Hence, training needs to be more hands on, interactive and activity oriented.
Adults need to be respected and the environment of learning needs to be open andnon-judgmental.
Adult learners need to be facilitated to learn and not directed to do.
Immediate feedback would help them learn better.
Tips on conducting a training session
Start each session with an introduction to evoke interest in the topic of discussion
Maintain eye contact and establish rapport with the participants
Relate to the previous topics discussed
Provide learners with as many real life experiences as possible and examples
At the end of session, summarize the main points of learning
“What I hear, I forget;
What I see, I remember;
What I do, I understand.”– Confucius 451 BC
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Interactive training session
Advantages of interactive sessions:
It helps maintaining the learner’s interest and avoids monotony
As adult learners they think
The learners get involved in their learning.
The point of view of the learners gets a hearing and at the same time if anymisconceptions can be corrected.
Any doubts can be cleared
Disadvantages of interactive sessions:
Effectiveness of interactive session depends on the moderator’s capacity of handling theinteraction
Some participants dominate the interaction and some may not participate in thediscussion
The discussion can go tangentially in a different direction; the main objective would getsidelined.
Demonstration / activity
Tips for Demonstration / activity:
State the objective of demonstration
Demonstrate the steps in the correct sequence with appropriate materials andequipment
Make sure that the demonstration is visible to all
Never demonstrate the skill or activity incorrectly
Explain each step so that it is understood by all
Encourage questions and suggestions
Advantages of Demonstration:
Demonstration helps in observation of skill
It reinforces the correct method of preparation
Disadvantages of demonstration:
It is time consuming
Difficult for a large gathering
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Bibliography
1. Full sized project document submitted for request for Project preparation grant 2008.
Environmentally sound management of Medical waste India, Global environment facility,
UNIDO.
2. Biomedical Waste Management Rules, 2016. Ministry of Environmental, Forest and Climate
Change, Government of India. Published by Controller of Publications: New Delhi;2016
available at http://envfor.nic.in/sites/default/files/BMW-Rules%2C-2016_English.pdf
3. Health care waste management. 2017 WHO available at https://www.healthcare-waste.org/
accessed on 1st Jan 2018
4. Health care waste. [Online]. [cited 2017 January 21]; Available from: URL:
http://www.who.int/mediacentre/factsheets/fs253/en/
5. International and National HCWMC laws – Legislative, regulatory and policy aspects. Module 3
WHO, Global Health care waste project, GEF available on
http://www.who.int/water_sanitation_health/facilities/waste/module3.pdf accessed on 1st Jan
2018
6. Overview of Basel convention. Basel Convention. 1989
http://www.basel.int/TheConvention/Overview/tabid/1271/Default.aspx accessed on 25th Dec
2017
7. Stockholm convention 2001. http://chm.pops.int/Home/tabid/2121/Default.aspx accessed on 25th
December 2017
8. Minamata convention
9. The salient features of BMWM rules 2016. Available at
http://pib.nic.in/newsite/PrintRelease.aspx?relid=138353%20
10. Major changes in BMWM rules 2016. Available at
http://pibphoto.nic.in/documents/rlink/2016/mar/p201632701.pdf accessed on 25th Dec
2017
11. Facilitation skills and method of adult education. 2011 Available at
http://www.kas.de/wf/doc/kas_29778-1522-2-30.pdf?111219190929 accessed on 15th nov
2017
12. Knowles, M. S. (1980). The Modern Practice of Adult Education: From Pedagogy to
Andragogy. New York: Cambridge.
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Annexure-1 Pre-test and Post-test Questionnaire
Training component of the project “Environmentally Sound Management of Medical Wastes in India”
GEF / UNIDO / MoEFCC/ MSRMC Endeavor
Pre-test / post-test questionnaire
1. Name: ………………………………………………………………………………………..…2. Name of Health Care Facility/ CBWTF: ………………………………………………………3. Designation: ……………………………………………………………………………………4. No. of years employed in the current facility: …………………………………………………5. Type of HCF: - 1) small :< 100 beds 2) medium: 101-500beds 3) large :> 500beds
EVALUATION FORMAT Pre Test: Post Test:
Dear Friend, The following questions help each one of us to do the self-evaluation. It is hoped that at the end of all the sessions we will be able to know what we really learned. Kindly fill them with in next 20 minutes, and kindly answer all the questions. Enter appropriate code in the last column given.
Question Response
1. Hazards of improper waste management is / area. Risk of infections and injuriesb. Air pollutionc. Water pollutiond. All of the above
2. The most CRITICAL component for Safe Management of Biomedical Waste isa. Segregation at Point of Generationb. Disinfectionc. Proper disposal of Infectious wasted. Use of personal protective devices
3. The following personal protective equipment must be used while cleaningcontaminated instruments
a. Maskb. Glovesc. Aprond. Goggles
37 | P a g e
is a. Tuberculosisb. Malariac. Hepatitis Bd. None of the above
5. According to Biomedical waste management (BMWM) Rules 2016, how manycategories of biomedical waste are generated
a. 4b. 5c. 6d. 10
6. Segregation is best achieved ata. Point of generationb. Intermediate storagec. Final storaged. Final disposal
7. Which of the following is the Biohazard symbol?a. c.
b. d.
8. The Stockholm convention is a global treaty to protect human health froma. Greenhouse gasesb. Persistent Organic Pollutantsc. Hospital acquired Infectionsd. Waste sharps
9. Of the total waste generated from a health care facility, the proportion of infectiousand hazardous waste is
a. 10 – 20%b. 30 – 40%c. 50 – 60%d. 80 – 90%
10. According to BMWM Rules 2016, infectious waste shall not be stored beyonda. 24 hoursb. 48 hoursc. 72 hoursd. 96 hours
11. All the following steps should be followed after needle stick injury EXCEPTa. Exposed parts to be washed with soap and waterb. Pricked finger should be kept in antiseptic lotionc. Pricked finger should not be squeezedd. Report all needle stick injury even if it doesn’t bleed
Disease that has the predominant potential for transmission through infectious waste4.
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a. 36 hoursb. 48 hoursc. 60 hoursd. 72 hours
13. Recommended disinfectant by BMWM Rules 2016 used for handling spills would bea. 1% Sodium hypochloriteb. 10% Sodium hypochloritec. 1% Bleach Solutiond. 10% Bleach Solution
14. Recommendations for storage facilities for health care waste include all EXCEPTa. Should be impermeable floorb. Inaccessible for animals and birdsc. Afford easy access for all health care personneld. Easy access for waste –collection vehicle
15. Mercury spill is dangerous since its vapours primarily affecta. Nervous Systemb. Bloodc. Pancreasd. Heart
16. Which of the following should not be incinerated:a. Used IV Bottlesb. Plaster of Paris Castc. Expired drugsd. Placenta
17. According to BMWM rules 2016, which of the following waste should be pre-treatedat Health care facility level before putting into yellow bin
a. Expired drugsb. Blood bagsc. Chemical wasted. Placenta
18. For sharps waste, which type of container should be useda. Puncture proof and leak proof white containerb. Puncture Proof, leak proof and tamper proof white containerc. Puncture proof and leak proof white translucent containerd. Puncture Proof, leak proof and tamper proof white translucent container
19. Which of the following accidents needs to be reported immediately in form I to SPCB?a. Needle stick injuryb. Mercury spillsc. Blasts during handling of biomedical wasted. Exposure of eyes to body fluids
20. As per BMWM rules 2016, the quality of bags used for waste collection should bea. Non chlorinated plastic bags of more than or equal to 20 microns thicknessb. Non chlorinated plastic bags of more than or equal to 30 microns thicknessc. Non chlorinated plastic bags of more than or equal to 40 microns thicknessd. Non chlorinated plastic bags of more than or equal to 50 microns thickness
12. Post exposure prophylaxis is of no use if started later than
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21. Match the following waste types with respective colour codes for segregation
Type of waste Enter the Color code option Color code options
a. Body parts 1. Red
b. Catheter tubing 2. White
c. Discarded linen 3. Yellow
d. Expired drugs 4. Blue
e. Broken ampoule 5. Black
f. Blood bags 6. Green
g. Used Needles
h. Placenta
i. Dressings
j. Syringes with intact needles
k. Gloves
22. Score according to your opinion for the statements given below
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
5 4 3 2 1
Sl. No Statement Score
a. Managing biomedical waste is predominantly a job of waste handlers
b. Biomedical waste management is an environment issue
c. Improper management of biomedical waste does not affect me directly
d. Segregation will help reduce the cost of managing biomedical waste
e. Needle stick injuries without bleeding need not be reported
f. Biomedical waste management is everyone’s responsibility
g. Biomedical waste management is an occupational safety issue
h. Periodic training of health care workers on BMWM is essential
i. Recapping of needle prevents needle stick injury
j. Knowledge on final disposal will help us practice segregation better
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Annexure-2 Keys for the pre and post test
Question Correct key Question Correct key
1. D 11 B
2. A 12 D
3. B 13 A
4. C 14 C
5. A 15 A
6. A 16 A
7. C 17 B
8. B 18 D
9. A 19 C
10. B 20 D
Keys for the question no. 21
Type of waste Enter the Color code option Color code options
a. Body parts 3 1. Red
b. Catheter tubing 1 2. White
c. Discarded linen 3 3. Yellow
d. Expired drugs 3 4. Blue
e. Broken ampoule 4 5. Black
f. Blood bags 3 6. Green
g. Used Needles 2
h. Placenta 3
i. Dressings 3
j. Syringes with intact needles 2
k. Gloves 1
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Annexure-3 Waste Handler’s Evaluation Tool
Training component of the project
“Environmentally Sound Management of Medical Wastes in India” GEF / UNIDO / MoEFCC/ MSRMC Endeavor
GENERAL INFORMATION
1. Name: ………………………………………………………………………………………..…
2. Name of Health Care Facility/ CBWTF: ………………………………………………………
3. No. of years employed in the current facility: …………………………………………………
EVALUATION FORMAT Pre Test: Post Test:
Question Answer
1. Segregation is best achieved at a. Final disposal b. Point of generation c. Intermediate storage d. Final storage
B
2. Personnel who work for collection & storage need to a. Wear hard heavy duty rubber gloves, mask, apron, boots b. Wash hands thoroughly after handling the waste c. Be immunized against Tetanus, Hepatitis B d. All of the above
D
3. What should you not do in an event of a needle stick injury? a. Immediately wash the wound with antiseptic b. Report the injury as soon as possible to the nursing staff of that ward/OPD c. Details of injury should be entered in the injury register d. Post exposure Prophylaxis (PEP) should be started at least within 72 hours
A
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4. Match the following waste types with respective colour codes for segregation
Type of waste Enter the Color
(Yellow/ Red/ Blue/ White puncture proof container)
a. Used dressing material Yellow
b. Plastic catheter tube Red
c. Discarded linen Yellow
d. Needles White
e. Broken ampoule Blue
5. Which of the following is false?
a. Collection of waste in a closed trolley
b. Use of PPE ( gowns, masks, aprons, boots ) at all times
c. Same lifts and ramps for waste trolleys and patients
d. Hand wash after waste handling
C
6. When should we wash our hands?
a) After contact with body fluids or excretions, wound dressing True/ False
b) Moving from contaminated body site to another body part/ patient True/ False
c) After contact with soiled equipment like bed pan, lab equipment with specimen
True/ False
d) After handling any waste True/ False
7. State whether true or false.
a. Needles should be recapped after use. True/ False
b. Plastic waste from the hospitals can be sold to any plastic recycler True/ False
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